DEREK WILLIAM CLARK (NPI# 1518283589) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1518283589 |
| Entity Type | Individual |
| Full Name | DEREK WILLIAM CLARK |
| Credential | M.D. |
| Practice Address |
500 17th Ave Seattle WA 98122-5711 |
| Mailing Address |
Po Box 25608 Salt Lake City UT 84125-0608 |
| Practice Telephone | 2063202800 |
| Practice Fax Number | 2063202827 |
| Mailing Telephone | 2063204476 |
| Mailing Fax Number | 2065687043 |
| Enumeration Date | 2010-04-15 |
| Last Update Date | 2016-10-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
MD60658145 | WA | Allopathic & Osteopathic Physicians |
| N | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
MD158550 | OR | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083156061 | Derek Clark | Physical Therapist | 6349 Garners Ferry Rd, Columbia, SC 29209 | 2016-11-08 |
| 1487070942 | Derek Clark | Specialist/Technologist | 625 Beaver St, Leetsdale, PA 15056-1200 | 2014-03-07 |
| 1497161590 | Derek Clark | Orthotist | 5111 Juan Tabo Blvd Ne, Ste A, Albuquerque, NM 87111 | 2014-07-09 |
| 1124452073 | Derek Clark | Pharmacist | 3100 N Glassford Hill Rd, Prescott Valley, AZ 86314-2285 | 2013-08-28 |
| 1902059843 | Derek Dwight Clark | Physical Therapist | 116 Market St, Mannington, WV 26582-1131 | 2008-10-23 |
| Street Address |
500 17TH AVE |
| City | SEATTLE |
| State | WA |
| Zip Code | 98122-5711 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255331377 | Dennis Chong | Physical Medicine & Rehabilitation | 500 17th Ave, Wound Healing Center, Seattle, WA 98122-5711 | 2005-07-29 |
| 1922613074 | Caitlin Vosburgh | Registered Nurse | 500 17th Ave, Seattle, WA 98122-5711 | 2020-09-14 |
| 1942819404 | Elias Mounir Elias | Neurological Surgery | 500 17th Ave, Seattle, WA 98122-5711 | 2020-07-29 |
| 1164057360 | Christine Ann Schmer | Registered Nurse | 500 17th Ave, Seattle, WA 98122-5711 | 2020-03-08 |
| 1821623257 | Kirsten Elizabeth Wickstrom | Registered Nurse | 500 17th Ave, Seattle, WA 98122-5711 | 2020-03-05 |
| 1508499039 | Hodo Mohamud | Registered Nurse | 500 17th Ave, Seattle, WA 98122-5711 | 2020-02-12 |
| 1639709728 | Marian J Dobles | Pharmacist | 500 17th Ave, Seattle, WA 98122-5711 | 2020-01-17 |
| 1659910008 | Ayrron Sisley | Pharmacist | 500 17th Ave, Seattle, WA 98122-5711 | 2020-01-02 |
| 1639718687 | Monica Ste Marie | Pharmacist | 500 17th Ave, Seattle, WA 98122-5711 | 2019-12-21 |
| 1124666268 | Michael Kwik | Pharmacist | 500 17th Ave, Seattle, WA 98122-5711 | 2019-12-19 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053938506 | Quality Counseling and Consultation Service LLC | Counselor | 1525 Harvard Ave #509, Seattle, WA 98122 | 2020-07-01 |
| 1912535626 | Cesar Andrade | Student in an Organized Health Care Education/Training Program | 550 16th Avenue #400, Seattle, WA 98122 | 2020-03-29 |
| 1366089666 | Peter Nguyen | Pharmacy Technician | 914 East Jefferson Street, Campion Hall, Seattle, WA 98122 | 2019-12-05 |
| 1356903140 | Jason Dandino | Specialist/Technologist | 550 14th Avenue, Seattle, WA 98122 | 2019-07-02 |
| 1962066415 | Seattle Colleges | Local Education Agency (LEA) | Mainstay At Seattle Central College, 1701 Broadway Ms Be3210, Seattle, WA 98122 | 2019-04-30 |
| 1538621412 | Mitchell R Ornelas | Student in an Organized Health Care Education/Training Program | Swedish Family Medicine Residency Cherry Hill; 550 16th, Avenue #400, Seattle, WA 98122 | 2019-04-01 |
| 1003374265 | Michael Russell | Surgery | 747 Broadway Heath Building 10th Floor, Seattle, WA 98122 | 2019-03-06 |
| 1639646821 | Maritza E Cajiao | Doula | 747 Broadway, Seattle, Seattle, WA 98122 | 2018-10-25 |
| 1336616762 | Suzanna M Lovin | Social Worker | 401 Broadway, 1st Floor, Seattle, WA 98122 | 2018-10-24 |
| 1184137770 | Walter Franklin Krengel Jr. | Orthopaedic Surgery | 2000 1st Ave Suite 2201, Seattle, WA 98122 | 2017-11-06 |
| Find all providers in zip 98122 | ||||
| Taxonomy Code | 2084N0400X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Neurology |
| A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720608235 | Alexander John Arnold | Psychiatry & Neurology | 1959 Ne Pacific St, Rr650, Seattle, WA 98195 | 2020-04-24 |
| 1568872281 | Marie-sarah Gagne Brosseau | Psychiatry & Neurology | 1536 N 115th Street, Suite 130, Seattle, WA 98133 | 2014-05-02 |
| 1124361993 | Malveeka Sharma | Psychiatry & Neurology | 325 9th Ave Rm 3ct70, Seattle, WA 98104 | 2013-03-31 |
| 1053639690 | Nirupa Shah | Psychiatry & Neurology | 1734 Lake Washington Blvd, Seattle, WA 98122-3542 | 2010-05-06 |
| 1518292788 | Elham Rezvanian | Psychiatry & Neurology | University of Washington Medical Center Ss, 1959 North East Pacific Blvd, Seattle, WA 98195-0001 | 2009-10-06 |
| 1851528384 | Sarah Wahlster | Psychiatry & Neurology | 410 9th Ave N Fl 4, Seattle, WA 98109-4708 | 2009-06-11 |
| 1508050071 | Phillip Ault Ballard Jr. | Psychiatry & Neurology | 1229 Madison, Suite #820, Seattle, WA 98104-3539 | 2007-08-28 |
| 1265632855 | Shu-ching Hu | Psychiatry & Neurology | Harborbiew Medixcal Center, 325 9th Ave, Seattle, WA 98104 | 2007-07-20 |
| 1295801371 | Christopher Angus Lawrence | Psychiatry & Neurology | 2915 E Madison St, Suite 305, Seattle, WA 98112-4265 | 2006-11-28 |
| 1699846691 | Lawerence C Murphy | Psychiatry & Neurology | 600 Broadway Ste 200, Seattle, WA 98122-5373 | 2006-11-13 |
| Find all providers in SEATTLE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.